Hard Lesions Research Articles

Metastatic calcification and nephrosclerosis in an adult sloth (Choloepus hoffmani)

Clinical History: Multiple fragments of various organs from the necropsy of an adult sloth (Choloepus hoffmani) were received. The animal, prior to its death, had presented decay and poor general body condition, which is why it was euthanized. Necropsy Findings: According to the referring veterinarian, at necropsy, irregular and locally extensive hard yellowish lesions, were observed in the subcutaneous tissue of the thorax and abdomen. Similar lesions were observed in the tunica media of the aorta.

Bruxism: etiopathogenesis, diagnosis and its repercussions in adults. Review of the literature

Bruxism is defined as a repetitive muscular activity of the jaw, characterized by clenching, or grinding of the teeth due to dragging or thrusting of the jaw. It can manifest itself during sleep or wakefulness. The aim of this review is to establish the most important aspects of bruxism in adults, focusing on its etiology, diagnosis, and its repercussions in adults. The prevalence of sleep bruxism among adults ranges from 22% to 30% and between 1% to 15% for bruxism during wakefulness. Its etiology is associated with two groups of factors: central (psychological and pathophysiological) and peripheral (morphological). In diagnostic methods, it is found as possible (non-instrumental approach or self-report), probable (self-report and clinical examination) or definitive (self-report, clinical examination and polysomnography). The gold standard for the diagnosis of sleep bruxism is polysomnography. In terms of its repercussions, we can find different types of dental hard tissue lesions, mainly abfractions, attrition and mixed lesions. At the musculoskeletal level, the evidence is contradictory as it has been associated with muscle fatigue, sensitivity, and tension, but there is no linear cause-effect relationship. A direct and statistically significant relationship exists between sleep bruxism and morning headaches.

Case Description of Oral Cavity Hard Tissue Disease in Banjarmasin 2017-2020

Disease that rank first from the list of ten major diseases that are often complained by Indonesian people is oral cavity diseases. The Hard Tissue of oral cavity lesions can be in the form od caries, periodontal disease, periapical abnormalities, cysts, and tumor in the oral cavity. Based on the Riset Kesehatan Dasar (Riskesdas) in 2018 the prevalence of dental and oral problem in Indonesia in South Kalimantan was 59,6%. The purpose of this study is to determine the description of oral hard tissue lesions in Banjarmasin city in 2017-2020. This research is descriptive study using a cross sectional approach. The variables on this study were oral hard tissue disease and gender, the data used were secondary data that obtained from the recording and reporting of the LB-1 form at Banjarmasin Community Health Center. The results showed that the most common type of disease on oral hard tissue case in 2017-2020 was pulp and periapical tissue disease, in 2017 it was 12,640 cases (78.37%), in 2018 it was 18,184 cases (51,45%). In 2019 it was 22,493 cases (57.07%) and in 2020 it was 3,220 cases (58.59%). In 2017, the most cases were in men with total of 7,887 cases (62.50%),while in 2018, 2019, and 2020, the most cases were in women with a total of 11,621 cases (64,29%), 14,285 cases (63.51%) and 1,892 cases (58.76%). It is necessary to prevent oral hard tissue disease, especially in pulp and periapical tissue disease.

The role of EUS elastography-guided fine needle biopsy in the histological diagnosis of solid pancreatic lesions: a prospective exploratory study

This study aimed to evaluate the feasibility and efficacy of Endoscopic ultrasound elastography-guided fine needle biopsy (EUS-EG-FNB) for the diagnosis of pancreatic mass lesions. EUS-EG images were classified into heterogeneous and homogeneous groups. For the heterogeneous group, EUS-FNB was separately performed in both hard areas and soft areas. Only samples obtained during the first two passes (hard/soft areas) were used to compare the diagnostic accuracy as well as the quality and quantity of the specimens. We investigated the association of EUS-EG findings using strain histogram analysis with the histological findings. Fifty-five patients were enrolled including 25 patients with heterogeneous group. The homogeneous group had significantly lower mean strain value (hard) lesions. The adequate sampling rates from hard and soft areas were 88 and 92%, respectively (P = 0.6374). Comparison of the diagnostic accuracy and the quality and quantity of the histological core between hard and soft areas showed no significant differences. In pancreatic adenocarcinoma cases, the proportion of fibrous stroma in the core tissue was significantly correlated with the elasticity of the region. (R2 = 0.1226: P = 0.0022) EUS-EG may reflect tissue composition in pancreatic tumors, however, EUS-EG did not affect either the quality and quantity of the tissues obtained.Clinical Trial Registry No: UMIN-000033073.

S2341 Malignancy-Associated Pseudoachalasia: An Unusual Cause

Introduction: Achalasia is a rare motility disorder characterized by loss of inhibitory neurons of the myenteric plexus in the esophageal wall. Previous retrospective studies have suggested 4% of patients that present with achalasia-like symptoms and radiographic and esophageal manometric findings consistent achalasia will have causes of dysphagia besides primary achalasia, or pseudoachalasia. We describe a case of pseudoachalasia from a rare cause in a patient with dysphagia and weight loss. Case Description/Methods: An 84-year-old female presented with dysphagia for solids more than liquids, regurgitation of food, and 50 lbs weight loss over 6 months. The patient underwent high-resolution esophageal manometry (HREM) that demonstrated a hypertensive lower-esophageal sphincter. HREM also demonstrated failed peristalsis, incomplete bolus clearance, and pan-esophageal pressurization. An upper GI series demonstrated minimal passage of barium into the stomach, with a tapering of the esophagus with a bird beak-like pattern. The patient was referred for POEM for achalasia. At the start of the procedure, the GE junction was noted to be very tight and would not allow passage of the gastroscope. To advance the gastroscope into the stomach, balloon dilation over a guide wire was performed using a through-the-scope balloon. Endoscopic ultrasound (EUS) was then used to further evaluate the tight GE junction. EUS demonstrated heterogeneous thickening of the esophageal wall extending to the GE junction and gastric cardia. Several enlarged lymph nodes were seen adjacent to the infiltrative process. At the GE junction there was a solid, hard hypoechoic lesion that resisted passage of the endoscope. Pathologic and immunohistochemical analysis of a core tissue biopsy demonstrated atypical mesothelial cells suggestive of mesothelioma. Discussion: The epidemiology of pseudoachalasia remains uncertain given it is a rare mimicker of an already rare motility disorder. Malignancy can produce dysphagia through direct compression of the GE junction or due to submucosal invasion and disruption of the myenteric plexus. Especially in elderly patients, those with significant weight loss or a short duration of symptoms, a diagnosis of malignancy-related pseudoachalasia should be considered. As this case showed, all the other diagnostic testing in the workup of achalasia was consistent with achalasia and fooled us into missing an underlying cancer.

Oral Health Status of Illicit Drug Users in a Health District in South Africa.

The prevalence of illicit drug use and its associated oral health complications have been increasing in South Africa (SA). There has been a paucity of studies to determine the oral health status among illicit drug users in SA. This study aimed to determine the oral health knowledge, practices, and status of illicit drug users at rehabilitation centers in a district in SA. This was a cross-sectional study conducted at four rehabilitation centers in Pretoria, SA. Data were collected using a validated self-administered questionnaire and an oral examination. The questionnaire consisted of three parts: demographics, oral health knowledge, and oral health practices. The oral examination was conducted by a calibrated researcher and included caries, periodontal status, dental erosion, trauma, and soft tissue lesions. The data were analyzed using the Statistical Package for Social Sciences (SPSS) software. The mean age was 25.5 (±7.49) years with 91% being male. The majority (84%) of patients were Black, and almost all (87%) had never received oral health education; 55% were not aware that illicit drugs could have an impact on the oral health status and 40% had never had a prior dental consultation. The caries prevalence was 68% with a mean decayed, missing and filled teeth (DMFT) score of 5.3 (±6.18). More than half (58%) required periodontal treatment and there were minimal soft and hard tissue lesions diagnosed. Those who perceived their teeth to be in a poor condition had a significantly higher Decayed, Missing and Filled Teeth (DMFT) score compared with those who perceived their oral health to be good. Just under half (41.9%) of the participants did not need any periodontal intervention, with the other half presenting with plaque retention or calculus and thus needed oral hygiene intervention inclusive of scaling and polishing. There was minimal evidence of pathological oral lesions with only 1.5% presenting with necrotizing periodontal disease (NPD). Overall, there was generalized poor oral hygiene CONCLUSION: Many of the participants had poor oral hygiene knowledge and practices and a relatively high prevalence of caries. It is imperative that oral health promotion and education is incorporated into the medical interventions provided at rehabilitation centers.

ORAL MANIFESTATIONS OF COVID-19 INFECTION: AN ANALYTICAL CROSS SECTIONAL STUDY

TYPE: Abstract TOPIC: Chest Infections PURPOSE: The current COVID 19 pandemic has created a huge impact across the globe. Recent literature has reported the occurrence of varied oral lesions in COVID 19 patients in the form of sporadic case reports. This analytical cross-sectional study was carried out to gauge and understand the pattern of oral lesions in qualitative RT-PCR confirmed COVID 19 patients. METHODS: A cross-sectional study involving a total of 500 qualitative RT-PCR confirmed, hospitalized COVID-19 patients were meticulously scanned for any hard and soft tissue lesions developing concomitantly with the disease occurrence. RESULTS: This study included a total of 367 (73.4%) males and 133 (26.6%) female patients with a mean age of 53.46 ± 17.50 years. Almost 51.2% of patients presented with gustatory disturbance, 28% with xerostomia, and 15.4% of patients were found to have oral findings like erythema, ulcers, depapillation of the tongue. There was a statistically significant correlation between oral manifestations and disease severity (p= <0.001). CONCLUSIONS: COVID-19 is found to affect oral health with greater probability in patients with severe diseases (SARI) which may be due to disease itself, immune response, and lack of motivation for personal hygiene measures. CLINICAL IMPLICATIONS: COVID 19 infection is definitely found to have a significant effect on the oral health of the patients with increased findings in the severe form of the disease. As oral health care providers, it is important for us to understand the common presentations so that we can screen such patients and direct them to appropriate screening and testing centers. DISCLOSURE: Nothing to declare. KEYWORD: Covid 19, oral

Effects of periodontal clinical database software in resident training during COVID-19 pandemic: a prospective observational study

BackgroundDental residents in Guangdong, China, had fewer medical practice opportunities because of the pandemic of COVID-19. This study aimed to evaluate whether a case-based learning (CBL) approach using a periodontal clinical database software (PCDS) could improve residents' achievement in the exam of the standardized residency training (SRT) program.MethodsForty-four dental residents volunteered and completed this trial. Within 12 weeks, all residents admitted periodontal patients 5 days a week and participated in a case-based learning course using PCDS once a week. Two online case-based examinations were used to evaluate their diagnostic and therapeutic performance before and after training. The total accuracy rate of examinations and the accuracy rate of subitems were analyzed using paired samples T-test. The Bonferroni correction is used for multiple testing adjustments, and p < 0.05 was considered statistical significance.ResultsAfter training, the total accuracy rate of SRT exams raised from 65 to 76%. There was a significant difference in the accuracy rate before and after training (Mean = 0.103, SD = 0.141, p < 0.001). The accuracy of radiographic examination (type of alveolar bone absorption and hard tissue lesion of tooth) and making treatment plan was significantly improved after training (p < 0.005). However, residents' performance in diagnosing periodontitis and predicting the prognosis of affected teeth was not improved.ConclusionsThe PCDS and CBL method effectively improved the residents' achievement in SRT examination, especially in identifying the type of resorption of alveolar bone and the hard tissue lesion of a tooth by radiographic examination and making an appropriate treatment plan for a periodontitis patient. More effective teaching approaches are needed to improve residents' accuracy of diagnosis of periodontitis using the 2018 classification in China.

Foreign Body in the Hard Palate of Infant

Background: Foreign bodies adherent to the hard palate often mimic oral lesions. Case report: A 10-month-old female infant presented with the sudden development of a hard palate lesion. With photography and visualization, the “lesion” was a false nail, which belonged to the child’s caregiver. Discussion/conclusion: The differential diagnosis of palatal lesions in infants should include foreign bodies, and if identified as such, evaluation under anesthesia may be avoided.

Oral Manifestations of COVID-19 Infection: An Analytical Cross-Sectional Study.

ObjectivesThe current COVID-19 pandemic has created a huge impact across the globe. Recent literature has reported the occurrence of varied oral lesions in COVID-19 patients in the form of sporadic case reports. This analytical cross-sectional study was carried out to gauge and understand the pattern of oral lesions in qualitative RT-PCR-confirmed COVID-19 patients.MethodsA cross-sectional study involves a total of 500 qualitative RT-PCR confirmed, hospitalized COVID-19 patients who were meticulously scanned for any hard and soft tissue lesions developing concomitantly with the disease occurrence.ResultsThis study included a total of 367 (73.4%) males and 133 (26.6%) female patients with a mean age of 53.46 ± 17.50 years. Almost 51.2% of patients presented with gustatory disturbance, 28% with xerostomia and 15.4% of patients were found to have oral findings like erythema, ulcers, depapillation of tongue. There was a statistically significant correlation between oral manifestations and disease severity (p ≤ 0.001).ConclusionCOVID-19 is found to effect oral health with greater probability in patients with severe diseases (SARI) which may be due to disease itself, immune response and lack of motivation for personal hygiene measures.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12663-021-01679-x.

Role of Ultrasonography and Strain Elastography Findings in Peripheral Nerve Sheath Tumor

Peripheral nerve imaging science is rapidly advancing, for early and robust diagnosis of many ill-health conditions, especially in detection of tumors. Radiological imaging techniques provide dynamic, real-time assessment of anatomy which either can help in diagnosis or prognosis in peripheral nerve disorders. Peripheral nerve tumors are often evaluated with magnetic resonance imaging, although there are many advantages offered with ultrasonography (USG). Strain elastography (SE), another technique, is well known for the diagnosis of soft-tissue tumors and is used to evaluate tissue stiffness. Hard lesions are more resistant to extrinsic compression and show smaller strain, whereas soft lesions show larger strain. The narrative review provides insight in functioning and utility of USG and SE techniques in peripheral nerve sheath tumor diagnosis.

Spectrum of biopsied oral and maxillofacial lesions in a tertiary care hospital of Karachi, Pakistan

Objectives: The burden of benign and malignant maxillofacial lesions in developing countries has increased rapidly over the years. Objective of this study was to provide a spectrum of oral and maxillofacial lesions biopsied in a tertiary care hospital of Karachi, Pakistan and to contribute in baseline data of target population.&#x0D; Patients and methods: This descriptive cross sectional study was made of biopsies performed in patients presenting to OPD of Oral and Maxillofacial Surgery Department, Abbasi Shaheed Hospital Karachi, Pakistan, between July 2018 till June 2020. A total of 652 patients belonging to either gender, 18-75 years of age, incisional or excisional biopsy were included. Recurrent or previously diagnosed lesions and patients not willing to give informed consent were excluded. Data including age, gender, site and histopathological diagnosis was recorded on a performa. Descriptive statistical analysis was done using SPSS version 26.&#x0D; Result: Out of 652 biopsies performed, (82.9%, n=541) belonged to soft tissues and (17.1%, n=111) were hard tissue lesions. The mean age of patients was 41.82 years, with a male to female ratio of 2.9:1. The most frequent sites biopsied were buccal mucosa (50.9%, n=332) and posterior mandible (10.6%, n=69). Oral squamous cell carcinoma (OSCC) (55.1%, n=359) was the most commonly reported soft tissue lesion with major involved sites buccal mucosa (74.4%, n=267), dentoalveolar mucosa (8%, n=29) and lateral border of tongue (7.2%, n=26) and for hard tissue the most common lesion was ameloblastoma of posterior mandible (3.5%, n=23).&#x0D; Conclusion: This study provides useful information about distribution of oral and maxillofacial lesions and highlights OSCC as the single most frequent diagnosis involving a much younger male population.

FUNGAL DECEIT IN THE SETTING OF MYELODYSPLASTIC SYNDROME

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Myelodysplastic syndrome (MDS) refers to an heterogenous group of clonal hematopoietic disorders, characterized by peripheral blood cytopenia. This disorder may present with clinical manifestations of anemia, thrombocytopenia or neutropenia, including symptomatic anemia, progression to acute myeloid leukemia or infections. Patients with MDS and severe neutropenia are at high risk for bacterial infections, however infections may rarely occur secondary to fungal invasion. CASE PRESENTATION: This is a 71-year-old female with history of hypertension, hyperlipidemia, coronary artery disease and MDS with positive RAEB2 and p53, treated with decitabine. She was initially admitted with diagnosis of symptomatic anemia, after developing general malaise, with associated shortness of breath and lightheadedness 2 days prior. Denied fever, cough, chest pain, abdominal pain, hematemesis, hematochezia, melena, insect bites or recent travel. Vital signs showed temperature of 37°C, heart rate in 109 bpm and blood pressure of 115/70 mmHg. Initial physical exam was remarkable for conjunctival pallor. Laboratories revealed leukocytopenia of 0.7 x10^3/uL, anemia of 6.1 g/dL, thrombocytopenia in 95 x10^3/ uL and absolute neutrophil count in 0 cells/uL. Chest x-ray revealed no acute cardiopulmonary pathologies. She underwent transfusion of 2 units of PRBCs, after which hemoglobin levels reached 8.2 g/dL. Nevertheless, on the third day, she developed fever of 39.4C and non-productive cough, for which ongoing diagnosis of neutropenic fever was considered. Cultures were taken and was started on cefepime. Upon examination, she had decreased breath sounds and developed 1.5cm circular violaceous lesion on the left cheek, circular violaceous lesion on the hard palate, as well as, multiple 0.5cm circular violaceous lesions on the left lower extremity and abdomen. Chest CT scan exhibited bilateral upper consolidations, raising concern for possible disseminated Fusarium fungal infection, for which amphotericin B was started. Biopsies of the lower extremity's lesion, revealed cutaneous hemorrhage, however biopsy of the hard palate's lesion revealed aspergillus spp. These findings were consistent with invasive aspergillosis. DISCUSSION: Invasive aspergillosis refers to illness caused by pulmonary or extrapulmonary dissemination of Aspergillus spp. This condition is uncommon and occurs primarily in immunocompromised patients associated with therapy for hematologic malignancies, hematopoietic cell transplant or solid organ transplantation. Management should focus on prevention, prompt diagnosis, as well as early initiation of antifungal therapy. Surgery is reserved for severe cases. CONCLUSIONS: Tissue invasion is an unusual presentation of invasive aspergillosis, however its appearance in an immunocompromised individual should raise suspicion of fungal dissemination and further evaluation should be pursued. REFERENCE #1: M. Kousha, et al. European Respiratory Review 2011 20: 156-174 DISCLOSURES: No relevant relationships by Zulmarie Maisonet, source=Web Response No relevant relationships by Ivanisse Ortiz Velez, source=Web Response No relevant relationships by Francisco Tirado-Polo, source=Web Response No relevant relationships by Beltran Torres, source=Web Response No relevant relationships by Sharon Velez-Maymi, source=Web Response

Real Time Trans-Rectal Elastography of Prostate Correlation with Histopathology in a Suspected Case of Prostate Cancer

Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive.&#x0D; Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer.&#x0D; Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings.&#x0D; Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone.&#x0D; Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer.

Silver diamine fluoride as a minimally invasive and aerosol free approach in pediatric dentistry: An extensive case series

The current pandemic of COVID-19 warrants a repeal from conventional dentistry to an aerosol free, minimally invasive yet maximally effective clinical approach. Silver diamine fluoride (SDF) is an established modality for caries arrest in children fulfilling all the above. This extensive 25 case series highlights various clinical situations in which SDF was successfully used in children between 1-12 years of age with asymptomatic carious lesions of ICDAS score 2 or more in primary and permanent teeth. Primary outcome measure was caries arrest in the form of the hard and shiny lesion with no/minimal sensitivity. The secondary outcome measure was the zombie effect which was the residual staining on other tooth surfaces and indications of substantivity. SDF can be effectively and efficaciously used across different behaviour patterns and age groups of children in a various clinical scenario for both primary and permanent teeth routinely experienced in a paediatric dental office especially during these pandemic times with minimal aerosol generation.

Manifestation of Abdominal Lymphoma as Retroperitoneal Fibrosis in a Child: A Case Report

Non-Hodgkin’s lymphoma includes 60% of lymphoma cases in children and adolescents. Burkitt’s lymphoma and diffuse large B-cell lymphoma (DLBCL) patients usually have intra-abdominal tumors. Non-Hodgkin’s lymphoma (NHL) may present as retroperitoneal fibrosis (RF). In the present paper, a 7-year-old boy was reported who was hospitalized in our hospital because of stomachache, vomiting, and weight loss. In the patient’s history, it was found that 3 weeks ago, the patient complained of flank pain and suspected kidney stones, but urethroscopy revealed that he did not have kidney stones. After admission to our hospital, upon the examination of the abdomen, we noticed a palpable mass in the patient’s epigastric region. Diagnostic laparoscopy was performed, and a large number of hard lesions similar to fibrosis were detected in the mesogastric region, the first part of the small intestine, the head of the pancreas, and the liver. Finally, DLBCL was diagnosed in this patient.

Ear and pubic keloids in an adolescent girl, the experience of a successful treatment

Keloids are frequent connective tissue tumors characterized by a significant proliferation of fibroblasts and collagen with a recurrent and extensive tendency. They can be secondary to a solution of cutaneous continuity: surgical wound; vaccination; burn; hard inflammatory lesion. Sometimes spontaneous, and are more frequently observed in black populations [1-3]. We report the case of a 20 year old women, melanoderma, with no known pathological history who presented to our department with multifocal slightly pruritic tumor lesions evolving for 4 years on the auricle and the pubis. The patient and her companions thought of a mystical disease. The interrogation revealed that these lesions occurred after an ear piercing and folliculitis lesions on the pubic area. The examination revealed a good general condition, firm non sensitive normochromic tumor lesions of variable size with smooth surface, protruding and adherent to the deep plane located on the pubis and bilaterally on the auricle.

Keypoint detectors and texture analysis based comprehensive comparison in different color spaces for automatic detection of the optic disc in retinal fundus images

Detection of the optic disc which has similar brightness with the hard and soft exudate lesions seen in the early stage of diabetic retinopathy is very difficult due to different light conditions and contrast values. Automatic detection of these lesions by expert systems in the medical field is very important. In this context, we propose a new approach based on the analysis of color spaces, keypoint detectors, and texture for retinal fundus images. If the keypoint information is contained within the actual optic disc region, this is an important consideration for the automated detection of the optic disc. This study can be divided into five sections, respectively, image preprocessing, image processing, keypoint detection, texture analysis, and performance evaluation. The analyses of patch images compatible with the keypoints obtained from the Red–Green–Blue (RGB) image and its color channels were carried out. The performance of the study was validated on the Digital Retinal Images for Vessel Extraction public dataset. According to the results, Local Binary Pattern texture analysis performed in region of interest around keypoints detected by different keypoint detectors presented good performance in RGB and green channel images.

SOFT TISSUE OSTEOCHONDROMA

<h3>Background</h3> Extraskeletal osteochondroma are rare soft tissue tumors occurring in extra-osseous and extrasynovial structures with features of enchondral ossification. Cases have been reported in the hands and feet but are extremely rare in head and neck region. This is a report of a rare case in an extrasynovial location in the head and neck. <h3>Case Report</h3> A 45-year-old male patient presented with a hard tissue lesion in the chin area, with duration >10 years. Bimanual palpation revealed a freely movable 3 × 2 mm feely movable cartilage-like lesion with no attachment to the mandible. A small protrusion through the skin of the chin area was observed. Imaging also revealed a hard tissue lesion lying within the soft tissue. The lesion was excised along with the skin surrounding it. Histology revealed an encapsulated benign lesion arranged in layers of fibrous tissue covering a cap of hyaline cartilage transitioning to trabecular bone with more maturity toward the skin. Features were consistent with a diagnosis of soft tissue osteochondroma. The patient is currently healthy about 14 months after lesion excision. <h3>Discussion</h3> Extraskeletal osteochondromas are believed to be derived pluripotent cells of joint synovium, tenosynovium, and connective tissue. Computed tomography scan helps in demonstrating its extraskeletal location and magnetic resonance imaging helps delineate its borders. Clinicohistopathologically, it has to be differentiated from pseudomalignant osseous tumors, myositis ossificans, ossifying fibromyxoid tumors, and sarcomas. Osteochondroma should be included in the differential diagnosis of some head and neck soft tissue calcified masses. Diagnosis will be aided by adequate imaging and histopathologic examination.

Oral Health Status of Institutionalized Orphans and Non-Orphans Aged 6-12 Years in a Central Indian City: A Comparative Study

INTRODUCTION: Oral Health, like general health, is a basic fundamental right for all, and even more so for the underprivileged. AIM: To evaluate the oral health status of Institutionalized orphans aged 6-12 years and non-orphans in Indore, Madhya PradeshMATERIALS AND METHODS: The present descriptive cross-sectional study was conducted among various registered orphanages in Indore, Madhya Pradesh. Oral Examination was done by two standardized examiners (ADA type III examination) and data was entered using a pre-tested and pre-validated proforma. Data was transferred into MS excel and after application of descriptive statistics, the independent samples t-test and multiple logistic regression were applied (p value significant at ≤ 0.5). RESULTS: Of the total 263 study subjects, there were 132(50.2%) orphans and 131(49.8%) school children aged 6-12 years. Among orphans, males (62.9%) formed the majority; use of toothbrush with toothpaste was observed among 69.7% of orphans, while 6.1% did not use any oral hygiene aid. The most common observed hard lesion was dental caries (31.8%) as compared to 20.6% in school children and its presence revealed a significant association (p=0.02). CONCLUSION: It is recommended that a special emphasis should be made to promote oral health among the children residing in orphanages.